Early In-Hospital ARNI After MI: Promising but PARADISE-MI Anchors Caution

This meta-analysis pools 12 RCTs of early in-hospital sacubitril/valsartan versus ACEI/ARB in post-MI patients with LVEF below 50%, quantifying a MACE and ventricular arrhythmia signal that is heavily dependent on small, unblinded trials.

sacubitril/valsartanARNIACE inhibitorARBacute myocardial infarctionLV dysfunctionheart failureventricular arrhythmiaNT-proBNPmeta-analysissecondary preventionPARADISE-MI Cardiology / Anticoagulation

Background Information

Early ARNI therapy post-AMI cuts cardiovascular events by 42%.

Heart failure is a common complication after acute myocardial infarction (AMI) in patients with impaired left ventricular ejection fraction (LVEF). Early angiotensin-receptor-neprilysin inhibitor (ARNI) initiation reduced major adverse cardiovascular events (MACEs) by 42% and improved LVEF by 2.54%, but increased symptomatic hypotension risk. ARNI therapy shows promise for early post-AMI management, but the increased risk of hypotension requires careful monitoring. Early ARNI initiation post-AMI reduces MACEs and improves LVEF but watch for hypotension.

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Authors: Nguyen Q, Tran TTQ, Liao CT, Hung CL, Chang HY, Chen CW, Lin YC, Huang CY, Hsu CY

Citation: Nguyen Q, Tran TTQ, Liao CT, et al. Early in-hospital initiation of angiotensin-receptor-neprilysin inhibitor in post-acute myocardial infarction patients with impaired left ventricular systolic function: a systematic review and meta-analysis of randomized controlled trials. Frontiers in cardiovascular medicine. 2026;13:1877075. doi:10.3389/fcvm.2026.1877075

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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